Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

A Randomized Trial of Attention Training for Generalized Social Phobia: Does Attention Training Change Social Behavior?

The use of attention training protocols for the treatment of generalized social anxiety disorder (SAD) is undergoing increased examination. Initial investigations were positive but more recent investigations have been less supportive of the treatment paradigm. One significant limitation of current investigations is overreliance on self-report. In this investigation, we expanded on initial investigations by using a multimodal assessment of patient functioning (i.e., including behavioral assessment). Patients with a primary diagnosis of SAD (n = 31) were randomly assigned to eight sessions of attention training (n = 15) or placebo/control (n = 16). Participants were assessed at pre- and posttreatment via self- and clinician-report of social anxiety as well as anxious and behavioral response to two in vivo social interactions. Results revealed no differences between groups at posttreatment for all study outcome variables, suggesting a lack of effect for the attention training condition. The results are concordant with recent investigations finding a lack of support for the use of attention training as an efficacious treatment for patients with SAD.     

Artifacts as Conventional Objects

What underlies children's understanding of artifacts? Studies suggest that beginning around age 7, people reason about artifacts in terms of the inventor's purpose—termed the design stance. Our two studies emphasize another component of artifact understanding—the cultural nature of artifacts—by demonstrating people's sensitivity to an artifact's conventional use. In past studies participants were shown a novel artifact and told that someone invented it for a certain purpose and that later another person used it for a different purpose. Here we demonstrate that if participants are told that many people, as opposed to just one person, use an artifact differently, 5-year-olds, 7-year-olds, and adults do not strictly judge the artifact in terms of its invented purpose. We conclude that people's conceptions of artifacts are more complex and dynamic than has been suggested.     

Maternal Knowledge and Behaviors Regarding Discipline: The Effectiveness of a Hands-on Education Program in Positive Guidance

This study examined which method is most effective in supporting parents to use positive guidance techniques, a lecture-based only parent training series or a lecture-based plus hands-on parent training series. Maternal characteristics of depression, stress level, and attitudes towards positive guidance were explored as possible moderators. In this sample of 49 mother–child dyads, results indicated that the cognitive understanding of the use of positive guidance over time of the participants in the lecture-based only versus the lecture-based plus hands-on groups did not significantly differ. However, both groups improved in their cognitive understanding of positive guidance over time. Results also indicated that the behavioral use of positive guidance over time of the participants in both groups significantly differed. Further investigation revealed that, although the two groups did not differ in their behavioral use of positive guidance before the program, the lecture-based plus hands-on group improved over time whereas the lecture-based only group did not. Depression, stress level, and attitudes towards positive guidance did not moderate the effects of being in either group on participants’ behavioral use of positive guidance. Findings showed that all participants gained a better understanding of effective parenting techniques, but a hands-on component in parent training programs may be necessary for parents to incorporate these strategies into their parenting behaviors. The results have implications for early childhood professionals working with parents to address children’s behavior issues, as well as for the design of parent-support programs.     

“Getting to Know”: Exploring How Urban African American Women Conceptualize Safer and Risky Sexual Behaviors

The surge in the rate of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) cases continues to be most prevalent for African American women between the ages of 18 and 29, with heterosexual transmission remaining the primary cause of HIV spread for this population. The high rates of HIV/AIDS among African American women continue to emphasize the need for understanding how members of this population conceptualize sexual safety and risk. A qualitative research study using grounded theory methods was conducted to explore how African American women define safer and risky sexual behaviors. Interviews were conducted with 14 African American women between the ages of 18 and 29. The study findings suggest that African American women’s definitions of safer and risky sexual behaviors, while in a consensual sexual relationship, are consistently influenced by sex partner type. The information garnered from this study can help inform the development of HIV prevention strategies, health education, counseling and reproductive health services that support African American women’s wellness.     

Lateral differences in visual inspection time? The role of apparent motion cues

There are a number of reports of a left hemisphere advantage for visual inspection time, but some investigators employing slightly different methodologies have failed to replicate the effect. The present experiment was an attempt to identify one of the factors that could have lead to these discrepant findings: The role of apparent motion cues. In Experiment 1, a lateralized version of the inspection time task was administered via a computer monitor wherein the pi stimulus was masked with a figure vulnerable to apparent motion cues. With this mask, a strong left hemisphere advantage was observed. In Experiments 2 and 3, the test was administered on a tachistoscope or computer monitor, but in both cases the stimulus was masked with a pattern "forest" mask. Under these conditions, there was no lateral difference. This result implies that the left hemisphere advantage for inspection time relies on apparent motion cues.